scispace - formally typeset
Search or ask a question
Journal ArticleDOI

Executive dysfunction in Parkinson's disease: a review.

01 Sep 2013-Journal of Neuropsychology (John Wiley & Sons, Ltd)-Vol. 7, Iss: 2, pp 193-224
TL;DR: This review discusses how executive deficits relate to pathology in specific territories of the basal ganglia, consider the impact of dopaminergic treatment on executive function (EF) in this context, and review the changes in EFs with disease progression.
Abstract: Executive dysfunction can be present from the early stages of Parkinson's disease (PD). It is characterized by deficits in internal control of attention, set shifting, planning, inhibitory control, dual task performance, and on a range of decision-making and social cognition tasks. Treatment with dopaminergic medication has variable effects on executive deficits, improving some, leaving some unchanged, and worsening others. In this review, we start by defining the specific nature of executive dysfunction in PD and describe suitable neuropsychological tests. We then discuss how executive deficits relate to pathology in specific territories of the basal ganglia, consider the impact of dopaminergic treatment on executive function (EF) in this context, and review the changes in EFs with disease progression. In later sections, we summarize correlates of executive dysfunction in PD with motor performance (e.g., postural instability, freezing of gait) and a variety of psychiatric (e.g., depression, apathy) and other clinical symptoms, and finally discuss the implications of these for the patients' daily life.
Citations
More filters
Journal ArticleDOI
TL;DR: It is suggested that imbalance between goal-directed and habitual action and inhibition contributes to some manifestations of Parkinson's disease, Tourette syndrome and obsessive–compulsive disorder and is proposed that basal ganglia surgery improves these disorders by restoring a functional balance between facilitation and inhibition.
Abstract: Classically, the basal ganglia have been considered to have a role in producing habitual and goal-directed behaviours. In this article, we review recent evidence that expands this role, indicating that the basal ganglia are also involved in neural and behavioural inhibition in the motor and non-motor domains. We then distinguish between goal-directed and habitual (also known as automatic) inhibition mediated by fronto-striato-subthalamic-pallido-thalamo-cortical networks. We also suggest that imbalance between goal-directed and habitual action and inhibition contributes to some manifestations of Parkinson's disease, Tourette syndrome and obsessive-compulsive disorder. Finally, we propose that basal ganglia surgery improves these disorders by restoring a functional balance between facilitation and inhibition.

439 citations

Journal ArticleDOI
16 Apr 2015-Brain
TL;DR: It is argued that Parkinson’s disease dementia reflects dysfunction in seven distinct brain networks, with implications for therapeutic approaches.
Abstract: In the long-term, with progression of the illness, Parkinson's disease dementia affects up to 90% of patients with Parkinson's disease. With increasing life expectancy in western countries, Parkinson's disease dementia is set to become even more prevalent in the future. However, current treatments only give modest symptomatic benefit at best. New treatments are slow in development because unlike the pathological processes underlying the motor deficits of Parkinson's disease, the neural mechanisms underlying the dementing process and its associated cognitive deficits are still poorly understood. Recent insights from neuroscience research have begun to unravel the heterogeneous involvement of several distinct neural networks underlying the cognitive deficits in Parkinson's disease dementia, and their modulation by both dopaminergic and non-dopaminergic transmitter systems in the brain. In this review we collate emerging evidence regarding these distinct brain networks to give a novel perspective on the pathological mechanisms underlying Parkinson's disease dementia, and discuss how this may offer new therapeutic opportunities.

325 citations


Cites background from "Executive dysfunction in Parkinson'..."

  • ...…several cognitive abilities, including problem-solving, planning/sequencing, rule-shifting/maintenance, task-switching, manipulation in working memory and response inhibition (Dubois and Pillon, 1997; Kehagia et al., 2010; Parker et al., 2013; see Dirnberger and Jahanshahi, 2013 for review)....

    [...]

  • ...…and probabilistic classification learning) through ‘overdosing’ the relatively more intact limbic and orbitofrontal circuits in early Parkinson’s disease (Gotham et al., 1988; Swainson et al., 2000; Cools et al., 2001; Jahanshahi et al., 2010; see Dirnberger and Jahanshahi, 2013 for review)....

    [...]

Journal ArticleDOI
TL;DR: The aim of this review was to present and justify the different testing techniques and methods with their different quantitative and qualitative variables to make it possible to precisely evaluate each sensory, central, and motor component of the postural function according to the experiment protocol under consideration.
Abstract: The different techniques and methods employed as well as the different quantitative and qualitative variables measured in order to objectify postural control are often chosen without taking into account the population studied, the objective of the postural test, and the environmental conditions. For these reasons, the aim of this review was to present and justify the different testing techniques and methods with their different quantitative and qualitative variables to make it possible to precisely evaluate each sensory, central, and motor component of the postural function according to the experiment protocol under consideration. The main practical and technological methods and techniques used in evaluating postural control were explained and justified according to the experimental protocol defined. The main postural conditions (postural stance, visual condition, balance condition, and test duration) were also analyzed. Moreover, the mechanistic exploration of the postural function often requires implementing disturbing postural conditions by using motor disturbance (mechanical disturbance), sensory stimulation (sensory manipulation), and/or cognitive disturbance (cognitive task associated with maintaining postural balance) protocols. Each type of disturbance was tackled in order to facilitate understanding of subtle postural control mechanisms and the means to explore them.

305 citations

Journal ArticleDOI
08 Apr 2015-Neuron
TL;DR: It is proposed that motor module organization is disrupted and may be improved by therapy in spinal cord injury, stroke, and Parkinson's disease.

298 citations

Journal ArticleDOI
TL;DR: It is found that cortical thinning followed neural connectivity from a “disease reservoir” in Parkinson’s disease patients, suggesting that disease propagation to the cortex in PD follows neuronal connectivity and that disease spread to the cerebral cortex may herald the onset of cognitive impairment.
Abstract: Here we test the hypothesis that the neurodegenerative process in Parkinson’s disease (PD) moves stereotypically along neural networks, possibly reflecting the spread of toxic alpha-synuclein molecules. PD patients (n = 105) and matched controls (n = 57) underwent T1-MRI at entry and 1 year later as part of the Parkinson’s Progression Markers Initiative. Over this period, PD patients demonstrate significantly greater cortical thinning than controls in parts of the left occipital and bilateral frontal lobes and right somatomotor-sensory cortex. Cortical thinning is correlated to connectivity (measured functionally or structurally) to a “disease reservoir” evaluated by MRI at baseline. The atrophy pattern in the ventral frontal lobes resembles one described in certain cases of Alzheimer’s disease. Our findings suggest that disease propagation to the cortex in PD follows neuronal connectivity and that disease spread to the cortex may herald the onset of cognitive impairment. In Parkinson’s disease (PD), neurodegeneration spreads from the brainstem to the cerebral cortex. Here, in a longitudinal study of PD patients, the authors found that cortical thinning followed neural connectivity from a “disease reservoir”.

186 citations

References
More filters
Journal ArticleDOI
TL;DR: It is proposed that cognitive control stems from the active maintenance of patterns of activity in the prefrontal cortex that represent goals and the means to achieve them, which provide bias signals to other brain structures whose net effect is to guide the flow of activity along neural pathways that establish the proper mappings between inputs, internal states, and outputs needed to perform a given task.
Abstract: ▪ Abstract The prefrontal cortex has long been suspected to play an important role in cognitive control, in the ability to orchestrate thought and action in accordance with internal goals. Its neural basis, however, has remained a mystery. Here, we propose that cognitive control stems from the active maintenance of patterns of activity in the prefrontal cortex that represent goals and the means to achieve them. They provide bias signals to other brain structures whose net effect is to guide the flow of activity along neural pathways that establish the proper mappings between inputs, internal states, and outputs needed to perform a given task. We review neurophysiological, neurobiological, neuroimaging, and computational studies that support this theory and discuss its implications as well as further issues to be addressed

10,943 citations

01 Jan 1995

4,159 citations


"Executive dysfunction in Parkinson'..." refers background in this paper

  • ...Further component processes of EF noted by different researchers are concept formation, sequencing of complex actions, and cognitive flexibility (Anderson, Northam, Hendy, & Wrenall, 2001; Lafleche & Albert, 1995) while allocation of attention is implicitly included (Anderson et al., 2001; Lezak, 1995; Norman & Shallice, 1986)....

    [...]

  • ...It is a multi-faceted EF involving conceptual activity, impulse control, and sustained attention (Lezak, 1995)....

    [...]

  • ..., skills or stimuli) needed to formulate and carry out an intention and achieve a goal (Lezak, 1995)....

    [...]

Book ChapterDOI
01 Jan 1986
TL;DR: This chapter proposes a theoretical framework structured around the notion of a set of active schemas, organized according to the particular action sequences of which they are a part, awaiting the appropriate set of conditions so that they can become selected to control action.
Abstract: Much effort has been made to understand the role of attention in perception; much less effort has been placed on the role attention plays in the control of action Our goal in this chapter is to account for the role of attention in action, both when performance is automatic and when it is under deliberate conscious control We propose a theoretical framework structured around the notion of a set of active schemas, organized according to the particular action sequences of which they are a part, awaiting the appropriate set of conditions so that they can become selected to control action The analysis is therefore centered around actions, primarily external actions, but the same principles apply to internal actions—actions that involve only the cognitive processing mechanisms One major emphasis in the study of attentional processes is the distinction between controlled and automatic processing of perceptual inputs (eg, Shiffrin & Schneider, 1977) Our work here can be seen as complementary to the distinction between controlled and automatic processes: we examine action rather than perception; we emphasize the situations in which deliberate, conscious control of activity is desired rather than those that are automatic

4,060 citations